Insertion of a collagen plug to close an abdominal wall enterocutaneous fistula

The procedure

In this procedure a collagen plug is inserted into the fistula. The plug is made of polyurethane and animal tissue (such as pig intestine). The aim is to seal off the fistula where it joins the bowel, helping it to heal. The collagen plug fills the fistula and acts as a scaffold for tissue growth, allowing the fistula to heal.

There are a number of techniques that can be used to insert a collagen plug and most of these are done with the patient under sedation. One method uses X‑rays to see where the fistula leaves the bowel. A guide wire is inserted from outside the body, along the fistula tunnel and into the bowel. The collagen plug is pulled from inside the bowel into the fistula, to plug the hole. The fistula may have been cleaned first, to help the plug go in more easily and to improve healing. A silicone footplate on the end of the plug helps to secure it inside the bowel. The plug may also be attached to a disc that lies outside the body, against the skin, helping to keep it in place. The patient is usually kept in hospital for a few days of bed rest, to prevent the plug coming out and to encourage healing.